Methods for treatment of tumors

ABSTRACT

To obtain tumor-selective, photosensitizing drugs useful in the localization of neoplastic tissue and treatment of abnormal neoplastic tissue such as tumors, one of two methods is used. In the first method, a hydrolyzed mixture of the products of reaction of hematoporphyrin with acetic acid and sulfuric acid is cycled through a microporous membrane system to exclude low molecular weight products. In the second method, drugs are synthesized or derived from other pyrrole compounds. The drugs: (1) include two covalently bound groups, each with four rings, some of which are pyrroles such as phlorins, porphyrins, chlorins, substituted pyrroles, substituted chlorins or substituted phlorins, each group being arranged in a ring structure, connected covalently to another group and have a triplet energy state above 37.5 kilocalories per mole; (2) are soluble in water, forming an aggregate of over 10,000 molecular weight in water and have an affinity for each other compared to serum protein such that 10 to 100 percent remain self aggregated in serum protein; and (3) are lipophillic and able to disaggregate and attach to cell plasma, nuclear membrane, mitochondria, lysosomes and tissue. The drug obtained by the first method has an empirical formula of approximately C 68  H 70  N 8  O 11  or C 68  H 66  N 8  O 11  Na 4 . Neoplastic tissue retains the drug after it has cleared normal tissues and illumination results in necrosis. Moreover, other photosensitizing materials may be combined with a carrier that enters undesirable tissues and cells of the reticular endothelial system such as macrophages. These photosensitizing materials: (1) must have a triplet energy state above 3.5 kilocalories per mole; (2) cannot be easily oxidized; and (3) not physically quench any required energy state. Preferably, this photosensitizing material should be lipophilic.

RIGHTS IN THE U.S. GOVERNMENT

This invention was made with federal support under research grants CA30940-01 and CA 16717 and contract NO1-CM-97311, awarded by the NationalCancer Institute, U.S. Department of Health and Human Services. TheGovernment has certain rights to this invention.

RELATED CASES

This application is a continuation of Ser. No. 889,829, filed 7/24/86,now U.S. Pat. No. 4,866,168, which is continuation-in-part ofapplication Ser. No. 481,345, filed Apr. 1, 1983 now abandoned, whichwas a continuation-in-part of application Ser. No. 424,647, filed Sept.27, 1982 now abandoned, entitled, "Purified Hematoporphyrin Derivativefor Diagnosis and Treatment of Tumors, and Method".

BACKGROUND OF THE INVENTION

This invention relates to the diagnosis and treatment of undesirabletissue such as malignant tumors by certain drugs that accumulate in theundesirable tissue.

In one class of diagnosis and treatment with photosensitizing drugs,tumors are detected and treated by irradiating the tumors with lightafter the drug accumulates in the tumor. The drugs are photosensitizingand some of the drugs in this class are derivatives of hemoglobin.

There are several prior art techniques for such diagnosis and treatment.For example, in "Etudes Sur Les Aspects Offerts Par Des TumeurExperimentales Examinee A La Lumiere De Woods", CR Soc. Biol.91:1423-1424, 1924, Policard, the author, noted that some human andanimal tumors fluoresced when irradiated with a Wood's lamp. The redfluorescence was attributed to porphyrins produced in the tumor. In"Untersuschungen Uber Die Rolle Der Porphine Bei GeschwulstkrankenMenschen Und Tieren", Z Krebsforsch 53:65-68, 1942, Auler and Banzershowed that hematoporphyrin, a derivative of hemoglobin, would fluorescein tumors but not in normal tissues following systemic injection intorats.

In "Cancer Detection Therapy Affinity of Neoplastic Embryonic andTraumatized Regenerating Tissue For Porphyrins and Metalloporphyrins",Proc Soc Exptl Biol Med. 68: 640-641, 1948, Figge and co-workersdemonstrated that injected hemato-porphyrin would localize and fluorescein several types of tumors induced in mice. In "The Use of a Derivativeof Hematoporphyrin in Tumor Detection", J Natl Cancer Inst. 26:1-8,1961, Lipson and co-workers disclosed a crude material, prepared byacetic acid-sulfuric acid treatment of hematoporphyrin, said materialhaving a superior ability to localize in tumors.

The photosensitive characteristic of tumor-selective porphyrin compoundsalso make them useful in the treatment of tumors. In "PhotodynamicTherapy of Malignant Tumors", Lancet 2:1175-1177, 1973, Diamond andco-workers achieved tumor necrosis after lesion-bearing rats wereinjected with hematoporphyrin and exposed to white light. In"Photoradiation Therapy for the Treatment of Malignant Tumors", CancerRes. 38:2628-2635, 1978, and "Photoradiation in the Treatment ofRecurrent Breast Carcinoma", J Natl Cancer Inst. 62:231-237, 1979,Dougherty and co-workers reported using the crude Lipson hematoporphyrinderivative to accomplish photoradiation therapy on human patients.

The crude Lipson hematoporphyrin derivative has the ability to enter avariety of tissues and to be retained in tumor cells after it has mostlycleared the serum. Subsequent irradiation with red light excites thecrude Lipson derivative which in turn excites oxygen molecules. Theexcited oxygen molecules exist for a microsecond--long enough to attacktumor cell walls and effects necrosis. In "Effects of Photo-ActivatedPorphyrins in Cell Surface Properties", Biochem Soc Trans 5:139-140,1977, Kessel explained that cross-linking of proteins in tumor cellmembranes causes leakage and eventual cell disruption.

The crude Lipson hematoporphyrin derivative has several disadvantagessuch as: (1) it enters normal tissue and causes unacceptable damage tothe normal tissue when therapeutic light sufficient to treat largetumors is applied; (2) it does not clear normal tissue sufficiently soonand thus some patients are harmed by exposure to ordinary sunlight asmuch as thirty days following treatment with the drug; and (3) it doesnot have an optimum absorbance spectrum in a range that penetratestissue most effectively.

SUMMARY OF THE INVENTION

Accordingly, an object of the invention is to provide a purified ornovel photosensitizing drug that can be used to effect photoradiationlocation of neoplastic tissue and therapy of undesirable neoplastictissue such as tumors or hyperproliferatic tissue.

A still further object of the invention is to provide purified or novelphotosensitive drugs that are highly neoplastic-tissue selective.

A still further object of the invention is to provide novelphotosensitive drugs that rapidly clear normal tissue but do not rapidlyclear neoplastic tissue.

A still further object of the invention is to provide aneoplastic-tissue-selective drug that fluoresces, delineating malignancyand aiding in diagnosis.

A still further object of the invention is to provide a drug which isselective of certain pathogens within an animal or within blood, bloodplasma or serum or fractions thereof and permit photochemicaldestruction of the pathogens in vivo or in vitro.

A still further object of the invention is to provide a novel method ofproducing the above-identified drugs.

A still further object of the invention is to provide novel method andequipment for the localization and/or treatment of tumors and certainother tissue.

A still further object of the invention is to provide a method and drugsfor selectively entering cells for photodynamic or chemical action inconjunction with other agents.

In accordance with the above noted and other objects of the invention,photosensitizing, undesirable-tissue-selective drugs are obtained fromphlorin or chlorin or other pyrrole-containing molecules. Generally,these drugs are neoplastic-tissue selective including hyperproliferatictissue selective and tumors. These drugs are an effective in vivophotosensitizer and have the following properties: (1) they are retainedin malignant tissue; (2) their molecules are not easily disaggregatedfrom each other by serum protein; (3) they are efficient in producing aphotochemical effect in vivo which is toxic to cells or tissue; (4) theyabsorb light at wavelengths which penetrate tissue; (5) they arerelatively non-toxic in the absence of the photochemical effect ineffective doses; (6) they are readily cleared from normal tissues; (7)they have a triplet energy state above 37.5 kilocalories; (8) they arenot readily oxidized; (9) they don't readily quench required excitedstates; and (10) they are water soluble.

This drug is an improvement over earlier drugs because of itsselectivity. This selectivity occurs in one embodiment because the drughas the ability to remain self-associated in serum at least to somedegree for a certain period of time which is at least fifteen minutesand to bind within the cell. It is believed that the self-associationcauses the drug to be removed from normal tissue but retained inneoplastic tissue at least partly in some cases by the endothelial cellsof the tumors as well as by the tumor cells in higher concentrationsthan in most normal tissue and for longer periods of time than in mostnormal tissue.

In addition to selectivity, the drug must dissociate in the tissue or inlipids before it is energized by radiation to damage the neoplastictissue. This combination of self-association in serum and dissociationin lipids occurs, in one embodiment, because the individual moleculeshave sufficiently higher attraction for each other than for water toform aggregates of molecular weight greater than 10,000 and sufficientattraction for lipids compared to each other to dissociate in tissue.

The individual molecules each include two groups bound to each othereach including four rings, some of which are pyrroles such as phlorins,porphyrins, chlorins or substituted phlorins, pyrroles or chlorins, eachgroup forming a ring so that they have sufficient self-affinity to formaggregates of molecular weight above 10,000 in water, in isotonic salineand in the vascular system but may break down in neoplastic tissue andattach to the cell.

Moreover, other photosensitizing materials may be combined with acarrier that enters undesirable tissues and cells of the reticularendothelial system such as macrophages. These photosensitizingmaterials: (1) must have a triplet energy state above 37.5 kilocaloriesper mole; (2) cannot be easily oxidized; and (3) not physically quenchany required energy state. Preferably, this photosensitizing materialshould be lipophlic.

In one embodiment, a known reagent is formed by hydrolysis of thereaction mixture of hematoporphyrin and acetic-sulfuric acids. Asuitable drug is purified from this reagent by elimination of lowmolecular weight compounds by filtration through a microporous membrane.This drug contains porphyrins at least 50 percent of which, andpreferably more than 90 percent of which have the empirical formula ofapproximately C₆₈ H₇₀ N₈ O₁₁ or C₆₈ H₆₆ N₈ O₁₁ Na₄.

Other derivatives may be formed from this compound and it is believedother compounds may be formed either from other natural porphyrins or bysynthesis from other materials such as by polymerization of monomericpyrroles by dipyrollic intermediates, from pyrromethenes, frompyromethanes, from pyroketones, from open chain tetrapyrrolicintermediates, from bilanes, from oxobilanes and from bilines. They mayalso be derived from natural pigments such as chlorophyll andhemogloblin. Such suitable compounds are described more fully inPorphyrins and Metalloporphyrins by J. E. Falk and Kevin M. Smith, 1975,Elsevier Scientific Publishing Company, Amsterdam, New York and Oxford,the disclosure of which is incorporated herein.

Generally, the drugs are composed of groups of pyrroles or substitutedpyrroles combined in a pattern. That pattern includes as a basicgrouping a structure which is phlorin or a group of four pyrroles orcombinations of pyrroles and substituted pyrroles formed into a largerring. Two such rings are covalently bound to form a pair of units eachhaving four pyrrole groups or four groups at least some of which arepyrroles or substituted pyrroles. The molecules preferably have anabsorption spectrum which is within the range of wavelengths between 350nm and 1200 nm. The absorption spectrum should be tailored to thedesired penetration such as, for example, being strong in the red ornear infrared wavelengths (600-1200 nm) for large bulking tumors and inthe green or blue wavelengths such as 488 or 514 nm for superficialundesirable tissue.

In use for therapy, the drug is caused to enter the subject, where it iscleared from normal tissue sooner than from abnormal neoplastic tissue.After the drug has cleared normal tissue but before it has clearedabnormal neoplastic tissue, the abnormal neoplastic tissue may belocated by the luminescence of the drug in the abnormal neoplastictissue. The fluorescence may be observed with low intensity light someof which is within the drugs' absorbance spectrum or higher intensitylight, a portion of which is not in the drugs' absorbance spectrum.Similarly, the drug is absorbed and retained by certain pathogens afterit has cleared normal tissue.

To destroy the abnormal neoplastic tissue or pathogens, a higherintensity light having a frequency within the absorbance spectrum of thedrug is applied. A synergistic effect without substantial destruction oftissue by heat is achieved by applying heat before, during or after thelight radiation is applied and thus the tissue should be heated above39.5 degrees Celsius and preferably within the range of 40.5 and 45degrees Celsius. The increase in temperature may be achieved bytransmitting light near or in the infrared spectrum or microwaves to thetissue. The temperature change should be within two hours before or twohours after treatment with light.

In the alternative, higher power laser light within the absorptionspectrum of the drug causes thermal destruction of tissue which isinteractive with the photodynamic effect of the drug. This removes bulkytumors or obstructions by vaporization or vascular occlusion such as bycoagulation of blood.

DESCRIPTION OF THE DRAWINGS

The above noted and other features of the invention will be betterunderstood from the following detailed description, when considered withreference to the accompanying drawings, in which:

FIG. 1 is a mass spectrometry printout of a drug in its methyl esterform;

FIG. 2 is a visible light spectrum of a drug in a water solution;

FIGS. 3 and 3A are in combination an infrared spectrum of the drugdispersed in potassium bromide;

FIG. 4 is a carbon-13 nuclear magnetic resonance print-out of the drug,referenced to dimethyl sulfoxide;

FIGS. 5 and 5A are in combination a print-out from a Waters AssociatesVariable Wave Length Detector used in conjunction with its U BondpakC-18 column, showing various components of HpD including a peakformation representative of the drug;

FIGS. 6 and 6A are in combination a print-out from a Waters AssociatesVariable Wave Length Detector used in conjunction with its U BondpakC-18 column showing various components of the drug DHE;

FIG. 7 is a carbon-13 nuclear magnetic resonance print-out of the drug,referenced to tetramethylsilane in deuterated chloroform solvent.Magnification spectrum is shown in the ranges from 20-30 ppm and55-75ppm;

FIG. 8 is a block diagram of a system useful in practicing theinvention;

FIG. 9 is a block diagram of another system useful in practicing theinvention;

FIG. 10 is a simplified enlarged longitudinal sectional view of aportion of the system of FIG. 9;

FIG. 11 is a developed view of the portion of the system of FIG. 8 thatis shown in FIG. 10;

FIG. 12 is a simplified perspective view partly broken away of anotherembodiment of a portion of FIG. 9;

FIG. 13 is a perspective view partly broken away of another embodimentof a portion of the system of FIG. 9;

FIG. 14 is a longitudinal sectional view of the embodiment of FIG. 12;

FIG. 15 is an elevational view of still another embodiment of a portionof the system of FIG. 9;

FIG. 16 is a perspective view partly broken away of the embodiment ofFIG. 14;

FIG. 17 is a sectional view of a portion of the embodiment of FIG. 14;

FIG. 18 is a perspective simplified view, partly broken away of anotherembodiment of a portion of FIG. 8;

FIG. 19 is a schematic view of another portion of the embodiment of FIG.8; and

FIG. 20 is a block diagram of still another portion of the embodiment ofFIG. 9.

DETAILED DESCRIPTION General Description of the Drug

Each of the drugs may be classified into one of two classes, which are:(1) each molecule of the drug aggregates in water to aggregates having acombined molecular weight of above 10,000; or (2) units of the drug areencapsulated in a liposome and molecules include at least one suchphotosensitizing chemical group.

The aggregates in the former class are sufficiently large and havecharacteristics which cause them to be removed by the lymphatic systemso as to be excluded from most normal tissue and usually to enter and beretained by undesirable tissue, such as tumors. Because of the absenceof a lymphatic system, the drug is not removed effectively from thetumors. The drugs of this invention bind within the cells to plasmamembrane, nuclear membrane, mitochondria, and lysosomes. While it mayenter some normal tissue, generally there is a sufficient difference inthe rates of accumulation and removal between normal and undesirabletissue to provide selected conditions which permit treatment ofundesirable tissue without excessive damage to normal tissue.

The form of drugs which aggregate must be sufficiently lipophlic todissociate in lipids so that the aggregate is broken up within the tumorinto a form which: (1) readily absorbs light within the light spectrumof 350 to 1,200 nm in wavelength; and (2) causes photodynamic effects.Thus, the drug is soluble in water to form large aggregates in aqueoussuspension but sufficiently lipophilic to dissociate in neoplastictissue.

At least one porphyrin utilized in the past by therapists as part ofLipson's reagent without knowing that it existed therein, has thenecessary characteristics but in the prior art was utilized in a mixtureof porphyrins which had deleterious side effects. It was not known thatthe substance was an effective agent in Lipson's reagent or that itexisted therein because of its resistance to separation by liquidchromatography.

Reduced side effects are obtained from such a mixture of porphyrins whenthe mixture includes more than 50% of the drug and preferably 90% ormore by weight of the porphyrins should be the drug or a drug havingsimilar characteristics. With such a purified dosage, the porphyrinsclear normal tissue adequately before the neoplastic tissue in which thedrug has accumulated is exposed to light.

This drug (DHE) appears to be ineffective if it is in aggregates ofmolecular weight less than 10,000. Such lower molecular weightaggregates appear to be stable. Molecular weight of the aggregate inthis application means the sum of the molecular weights of the moleculesin an aggregate of molecules. An aggregate of molecules consists of agroup of molecules bound together by forces other than covalent bonds.

Other drugs such as certain phlorins or chlorins have been used eitherwith two groups bound together or single groups encapsulated in aliposome. In any drug, the drug must bind within the neoplastic tissueor release a drug that binds within the neoplastic tissue. Morespecifically, the drug includes compounds in which the individualmolecules include two groups, each of which includes either phlorin orrings of pyrroles or hydrogenated pyrroles, or substituted pyrrolesconnected in such a way as to expose planes of both rings to other drugmolecules.

With this structure, the attraction between molecules is greater thanthe attraction to water and thus molecules of the drug aggregate inaqueous suspensions. One such compound, dihematoporphyrin ether (DHE),purified from Lipson's reagent, is shown in formula 1 and another suchcompound, which is a chlorin, is shown in formula 2. The chlorin shownin formula 2 may be synthesized from chlorophyll or formed as aderivative from the compound of formula 1. The attraction to lipids is,however, sufficiently great to cause the aggregates to dissociate in alipid environment. Metallo derivatives of the active compounds may beused, provided they do not interfere with the photosensitizing propertyof the molecules. For example, magnesium derivatives continue to workbut copper derivatives do not.

GENERAL DESCRIPTION OF DRUG PREPARATION

First, for one embodiment, hematoporphyrin derivative is formed, usingprior art methods or novel methods similar to prior art methods. Thismixture contains a suitable drug. This suitable drug, when formed in thehematoporphyrin derivative, is normally in a mixture of otherundesirable porphyrins.

To separate the effective drug from the undesirable porphyrins, the pHis raised into a range between 6.5 and 12 and preferably 9.5 to form anaggregate and then the material is separated. The separation may be byfiltering, by precipitation, by gel electrophoresis, by centrifugationor by any other suitable means. For best results in filtering or othermethods such as centrifugation based on the aggregate size, the pH israised to 9.5 and filtering done at the high pH to remove otherporphyrins rapidly and completely. The filter should retain aggregatesof molecular weight above 10,000.

The pH must be adjusted during filtering because it tends to be reducedas the impurities are reduced. This is done by monitoring pH and addingan appropriate adjustor such as a base. To save time and water duringpurification, the concentration is increased to the lowest possiblevolume. This may, in an ideal system, be limited by solubility toprevent precipitation of the drug or the aggregation of undesirablesubstances.

In methods of separation based on affinity, a hydrophobic packing isused having a higher affinity for DHE than other porphyrins inhematoporphyrin derivative. DHE is selectively removed after otherporphyrins with a solvent higher than alcohol in the eluantrophic seriesfor reverse phase chromatography. More specifically, an inverse phasechromatographic column with packing of 5 micron spheres is used. THF maybe used as the solvent.

Of course, the drug formed from hematoporphyrin derivative may be formedby other methods. In the preferred embodiment the drug is DHE, which isseparated from hematoporphyrin derivative. However, DHE may be formedother ways and other compounds may be formed by other methods includingfrom combinations of pyrroles or substituted pyrroles. For example, adrug similar to DHE may be formed using other formation bonds than theoxygen bond or from other hematoporphyrin derivatives and thus not beethers. Moreover, such compounds may be synthesized instead from otherfeedstocks and still other compounds having the desired characteristicsmay be formed from other compounds such as chlorophylls.

A chlorin, the structure of which is not entirely known, has beencombined with DHE and shown to have some effect in vivo when light inits absorbance spectrum was used. Better results have been obtained byencapsulating the same chlorin in liposome prepared using the methoddescribed by Dr. Eric Mayhew, "Handbook of Liposome Technology", Vol II,CRC Press, ed. G. Gregoriodis, the disclosure of which is incorporatedherein. A molar ratio of 1:4:5 of egg phosphatidyl, glycerol,phosphatidyl choline, cholesterol was used.

GENERAL DESCRIPTION OF TREATMENT

For treatment, a photosensitizing drug is injected into the subjectwhich drug includes a plurality of molecules that: (1) aggregate in anaqueous suspension into groups having a molecular weight above 10,000 orare encapsulated in another material that enters cells; and (2)dissociate and attach themselves in neoplastic tissue. The drug is thenpermitted to clear normal tissue and the neoplastic tissue is exposed toelectromagnetic radiation having a power at a value in a range ofbetween 5 milliwatts per square centimeter and 0.75 watts per squarecentimeter without thermal effects in a wavelength band of between 350nm and 1,200 nm to destroy the vascular system and other tissue withinthe neoplastic tissue that has accumulated the drug.

In treating humans or other mammals with the drug, light is irradiatedon the tissue in such a position as to uniformly illuminate the cancertissue. A synergistic effect is obtained by applying heat either before,during or after the light to heat the tissue above 39.5 degrees Celsiusand preferably within the range of 40.5 to 45 degrees Celsius.

The increase in temperature, when used, may be achieved by transmittinglight: (1) some of which is near or in the infrared spectrum such as at1060 nm wavelength from a Nd-Yag laser for heat with the light at 630 nmfor interaction with the photosensitive drug; or (2) by microwaves suchas at 2450 MHz; or (3) by any other suitable means. The temperature ispreferably increased during the application of radiation within theabsorption spectrum of the photosensitive drug but may be caused insteadimmediately before or after, such as within two hours.

In the alternative, higher power laser light within the absorptionspectrum of the drug causes thermal destruction of tissue which isinteractive with the photodynamic effect of the drug. This removes bulkytumors or obstructions by vaporization or vascular occlusion such as bycoagulation of blood.

SPECIFIC DESCRIPTION OF THE DRUG

In the preferred embodiment, the drug DHE is a water soluble, highmolecular weight material derived by treating hematoporphyrinhydrochloride with acetic and sulfuric acids followed by appropriatehydrolysis an filtering to separate the drug based on its large size.Its failure to pass through a filter, such as the MilliPore Pellicon10,000 molecular weight filter pack, indicates a molecular weight inexcess of ten thousand and thus aggregated DHE.

Mass spectrometry of the new drug shows in FIG. 1 especially strongpeaks at mass numbers of 149, 219, 591, 609 and characteristic butsmaller peaks at 1200, 1218, 1290, 1809. Spectrophotometry of the neworange-red colored drug in aqueous solution reveals in FIG. 2well-defined peaks at approximately 505, 537, 565 and 615 millimicrons.Infrared spectrophotometry of the new drug dispersed in potassiumbromide, reveals in FIG. 3 a broad peak associated with hydrogenstretching, said peak centered at approximately 3.0 microns, and ashoulder at approximately 3.4 microns. Finer peaks are observed atapproximately 6.4, 7.1, 8.1, 9.4, 12 and 15 microns.

Elemental analysis of the disodium salt derivative of the new drug showsit to have an empirical formula of C₃₄ H₃₅₋₃₆ N₄ O₅₋₆ Na₂, there beingsome uncertainty in hydrogen and oxygen due to traces of water whichcannot be removed from the drug. A carbon-13 nuclear magnetic resonancestudy of the drug in completely deuterated dimethylsulfoxide shows inFIG. 4 peaks at approximately 9.0 ppm for --CH₃ 18.9 ppm for --CH₂, 24.7ppm for CH₃ CHOH, 34.5 ppm for --CH₂, 62 ppm for CH₃ CHOH, 94.5 ppm for═C (methine), 130-145 ppm for ring C, and 171.7 ppm for C═O, all ppmbeing relative to dimethyl sulfoxide resonance at about 37.5 ppm.Additional vinyl peaks at approximately 118 and 127 ppm may berepresentative of the new drug or possibly a contaminant.

When the unfiltered reaction product was eluted from a WatersAssociates' U Bandpak C-18 column using first, successively methanol,water and acetic acid (20:5:1) and then using tetrahydrofuran and water(4:1), four components were found. Three by-products were identified ashematoporphyrin, hydroxyethylvinyldeuteroporphyrin and protoporphyrin bycomparison with standards on thin layer chromatography, with Rf valuesof approximately 0.19, 0.23, and 0.39 respectively (FIG. 5) usingBrinkman SIL silica plates and benzene-methanol-water (60:40:15) aselutent.

The fourth component shown in FIG. 5 was the biologically active drug ofthe invention. Chromatography shows in FIG. 6 that exclusion of theabove identified impurities using the MilliPore Pellicon cassette systemfitted with a 10,000 molecular weight filter pack, has occurred, duringprocessing of the drug of the invention.

In formula 1, DHE, which is a biologically active drug of thisinvention, is probably an aggregate of ether molecules formed betweentwo hematoporphyrin molecules by linkage of the hydroxyethylvinyl groupsas shown in formula 1. This linkage may occur through hydroxyethylvinylgroups in position 3- or 8- as numbered in formula 1. Linkage may beachieved at position 3- in both halves of the ether, at position 8- inboth halves of the ether or through position 3- in one half of the etherand in position 8- in the other half of the ether.

These structures may be named as derivatives of ethyl ether, i.e.: Bis-1- [3-(1-hydroxylethyl) deuteroporphyrin -8-yl] ethyl ether, as shownin formula 1. Other structured isomers may be named: 1-[3-(1-hydroxyethyl) deuteroporphyrin -8-yl]-1'- [8- (1-hydroxyethyl)deuteroporphyrin -3-yl] ethyl ether, or 1- [8-(1-hydroxyethyl)deuteroporphyrin -3-yl]-1'-[3-(1-hydroxyethyl) deuteroporphyrin -8-yl]ethyl ether, and Bis -1- [8- (1-hydroxyethyl) deuteroporphyrin -3-yl]ethyl ether.

One or both hydroxyethyl groups at positions 3- or 8-, not used in etherformation, may dehydrate to form vinyl groups. Although experiments havenot been conducted, experience indicates that ethers as shown in formula1 might be substituted with various combinations of hydrogen, alkylgroups, carboxylic acid groups and alcohol-containing groups at variouslocations of the structure. In addition, many possible optical isomersof these structures exist.

A carbon-13 nuclear magnetic resonance study of the drug in deuteratedchloroform referenced to tetramethysilane reveals in FIG. 7 twoadditional absorbances not previously apparent in FIG. 4. Peaks at 24.7ppm and 62 ppm in FIG. 4 have shifted to 25.9 ppm and 65.3 ppmrespectively in FIG. 7 but newly-developed peaks at 27.9 ppm and 68.4ppm in FIG. 7 represent resonances for CH₃ and H-C-OH bonded fromposition 3- in FIG. 7, respectively. These newly-developed resonancessubstantiate the molecular formula depicted in formula 1. ##STR1##

Although DHE is the preferred embodiment, other photosensitizingcompounds and delivery systems having the desired ability to enterneoplastic tissue and bind to cells have been prepared and still othersare possible. For example, the compound in formula 2, which is a chlorinand the compound in formula 3, which is a phlorin probably will show aresponse.

A chlorin has been tested and shown to have a response in animalsalthough not as satisfactory as DHE. The exact structure of that chlorinis not known but its spectrum shows it to be a chlorin. This chlorindoes not have delivery characteristics because it includes only onechlorin group rather than two groups. Delivery into tumors wasaccomplished by encapsulating the chlorin in a liposome to enter cellsand also by mixing with DHE. The chlorin was bound within the cell, wasirradiated and a response observed. For proper delivery, the compoundsmust either be encapsulated or have two covalently bound groups, eachgroup including four rings forming a larger ring which is the group,some of the rings being pyrroles such as chlorins, phlorins, porphyrinsand the like.

SPECIFIC DESCRIPTION OF DRUG FORMATION

To prepare one form of a drug from hematoporphyrin, the porphyrin isreacted to form compounds including two porphyrins covalently bound.This reaction is a dehydration reaction to form an ether (DHE) or acondensation reaction for a carbon-carbon linkage which may be possibleor any other possible combination of atoms. Moreover, a third linkingmolecule may be used such as dihaloalykyl compound, which reacts withthe hydroxl groups on two porphyrins.

DHE is formed by: (1) lowering the pH of a hematoporphyrin compound toreact a hydroxyl group on one of two porphyrins with another porphyrinand thus to form an ether containing the two rings of pyrroles; and (2)removing the DHE formed by this reaction from other moieties.

In another method of forming the ether, a mixture consisting ofapproximately 20% hematoporphyrin, 50% hematoporphyrin diacetate, 30%hematoporphyrin monoacetate is formed from hematoporphyrin hydrochlorideand hydrolyzed. These reactions may be generally expressed by equations4 and 5, or more specifically by equations 6 and 7 where P is the basicporphyrin group, the peripheral group of which has been acetylated asshown. This mixture is formed by: (1) adding 285 ml (milliliters) ofacetic acid to a 1000 ml Erlenmeyer flask containing Teflon-coatedmagnetic stirring bar; (2) stirring the acetic acid; (3) slowly adding15 ml of concentrated sulfuric acid; (4) weighing out 15.0 grams ofhematoporphyrin hydrochloride (preferably obtained from RousselCorporation, Paris, France); (6) adding said hematoporphyrinhydrochloride to the acid solution; and (7) stirring for one hour.##STR2##

To further the preparation of DHE: (1) a solution of 150 grams of sodiumacetate is prepared in 3 liters of glass-distilled water using a 4-literglass beaker; (2) at the end of one hour, the acetate mixture isfiltered, preferably through Whatman No. 1 filter paper, allowing thefiltrate to drip into the 4-liter beaker of 5% sodium acetate; (3) the5% sodium acetate solution now contains a dark red precipitate which ispreferably allowed to stand for one hour with occasional stirring; (4)the dark red precipitate is then again filtered, preferably using theabove-identified filter mechanism; (5) the filter cake from thefiltering process is then washed with glass-distilled water until thefiltrate is at pH of 5.5-6.0 (1500-2500 ml of wash water may berequired); and (6) the filter cake is then preferably allowed to dry inair at room temperature.

To further purify the DHE, the air-dried precipitate is ground, usingfor instance, a mortar and pestle until a fine powder is obtained. Thepowder may then be transferred to a 250 ml round bottom flask. The flaskis then attached to a rotating evaporator and rotation under vacuum ismaintained at room temperature for preferably 24 hours.

Twenty grams of the vacuum-dried powder is then preferably placed in a4-liter aspirator bottle which may contain a magnetic stirring bar, andthen 1000 ml of 0.1N sodium hydroxide is added thereto. This solution ispreferably stirred for one hour and 1.0N hydrochloric acid is then addeddropwise until the pH is 9.5.

For the separation of DHE, the aspirator bottle, containing the saidsolution, is attached to transfer lines leading to a MilliPore PelliconCassette system fitted with a 10,000 molecular weight filter pack of thetype sold by Millipore Corporation, Bedford, Mass. 01730. The pH of thesolution is maintained at 9.5 during this filtration process. It ispreferably that the temperature of the solution be ambient. Theconcentration is increased until the total volume is 400 ml by turningoff the feed water and continuing the pump.

The peristallic feed pump is continued and the water feed solution isrun through the Pellicon cassette system at a pH of 9.5 and pressure of10-20 p.s.i.g. and maintaining the retentate volume at 400 ml. Pressuremay be varied depending on the flow rate through the system.

The filtration process is continued until the retentate solutioncontains substantially only the high molecular weight, biologicallyactive product. At this time waste monomers are generally no longerpresent. Exclusion of the waste through the microporous membrane of thefilter system is confirmed by analyzing the high molecular weight,biologically active product with a Bio-Gel P-10 column obtainable forexample from Bio-Rad, Richmond, Calif. or by high performance liquidchromatography using a Micro-Bondpak C-18 column with fixed variablewavelength detector obtainable for example, from Waters Association,Milford, Mass.

Concentrations of the product may be increased by running the Pelliconcassette system without water feed. Concentrations of the product may bedecreased by adding water. In the preferred embodiment, theconcentration of the new drug in solution is approximately 2.5 mg/cc.The pH is adjusted to approximately 7.4 and made isotonic for bottling.

SPECIFIC DESCRIPTION OF TREATMENT

The photosensitizing drug is injected into the subject and approximately3 hours to 2 days is permitted to elapse before applying light. Thistime may differ in accordance with the patient and treatment but shouldbe adequate to permit the drug to clear normal tissue.

In FIG. 8 there is shown a block diagram of one system for irradiatingundesirable tissue having a light source 10 which may be a laser system,a radiation monitor and control system shown generally at 12 and adelivery system shown generally at 14, positioned to radiate a tumor.The light source 10 generally radiates light of the desired frequencyand may be a fluorescent lamp system or a laser system of any of severaltypes, such as an argon laser pumping a dye laser, a krypton laser orthe like. The light passes through the radiation monitor and controlsystem 12 for delivery through a fiber optic delivery system to a sourceof undesirable tissue.

The light source 10 includes different configurations such as a singleargon laser pumping a dye laser, two parallel sets of argon laserspumping a dye laser, a krypton laser or a xenon laser. Laserarrangements or other light sources are selected in accordance with thedrug and the function. For example, a diagnostic use may call for adifferent system than a therapeutic treatment of a tumor. The lasersystem 10 may contain the appropriate means to control frequency,duration and intensity of radiation or the radiation control system 12may have some or all of such means as part of it.

The power applied to the subject should be between 5 milliwatts persquare centimeter and 3/4 of a watt per square centimeter withoutthermal effects, and with thermal effects, 1/2 watt to a kilowatt persquare centimeter.

The energy application should be at a selected value within the range offrom 5 joules per square centimeter to 1,000 joules per squarecentimeter within a time period for which there is no substantialrepair, such as less than two hours. For longer periods, when eitherintermittent or continuous application is used, more energy may berequired.

The radiation monitor and control system 12 includes a light interfacesystem 20, a monitor system 22 and a power level control system 23. Thelight interface system 20 transmits light from the laser system 10through the delivery system 14 and transmits signals to the monitorsystem 22, indicating the intensity of light transmitted to the deliverysystem 14. It also receives feedback light from the delivery system 14and transmits a signal representing that light to the monitor system 22.The signals between the monitor system 22 and the light interface system20 are electrical. A power level control system 23 is connected to themonitor system 22 and to the laser system 10 to control the laser system10.

The monitor system 22 may have different configurations each with adifferent complexity. In one arrangement, the manual controls for thelaser system 10 are on the monitor and control system 22 such as on thepower level control 23 in some of these configurations, feedback signalsare applied from the monitor system 22 to the power level control 23 tocontrol intensity and sampling rates for purposes of determiningtherapeutic effects. The monitor system 22 may include data processingequipment and equipment which displays the results of the laser system10 and the light interface system 20 on an oscilloscope. The power levelcontrol 23 may be considered part of the laser system by somemanufacturers but is discussed separately here for convenience.

The light interface system 20 includes an optical interface and a sensor28. The optical interface and the sensor 28 are enclosed within acabinet for the shielding of light and electrical conductors 36 connectthe sensor 28 to the monitor system 22.

To transmit light from the laser system 10 to the delivery system 14,the optical interface includes a beam splitter 30 and a lens system 32having a shutter 33 and a lens 35. The beam splitter 30 passes lightfrom the laser system 10 to the lens system 32 for transmission throughthe delivery system 14 to the spot of therapy and to the sensor 28 fordetection. Light is transmitted through the delivery system 14 to aleakage detector at 37 which includes a light sensor electricallyconnected to the monitor system 22 and the power level control system23.

The delivery system 14 includes light conductors 40 and a lighttransmission unit 42 connected together so that the light conductors 40receive light from the lens system 32. There may optionally be includedother types of equipment such has an endoscope.

To monitor the therapy, the monitor system 22 includes a readout system25, an integrator 27 and a readout system 29. The light sensor 28applies signals to the readout system 25 which, in one embodiment, usesthe signals to control the power level control 23 in accordance withlight from the beam splitter 30 indicating laser output to the fibers 40from the laser system 10. The readout 25 also provides a visible readoutindicating power output from the laser system 10 as well as providingsignals to the power level control 23.

The leakage detector 37 applies signals to the readout 29, integrator 27and power level control 23. This signal can be used to calibrate theoutput from the delivery system 14 since it indicates loss in thedelivery system. This loss is a constant fraction of delivered light.The delivery system is calibrated by measuring its output in anintegrating sphere in a manner known in the art and correlating it withthe output from detector 37. With the relationship between leakage andoutput power known, a reliable feedback for monitoring and control isobtained which relates to power being transmitted through the lightconductor to the subject thus compensating for coupling losses to thelight conductor. The shutter 33 is controlled by the integrator 27 tocontrol the power dosage by blocking light to the delivery system 14when the integrated power or energy reaches a predetermined dosage setinto the integrator 27.

The delivery system is intended to: (1) deliver the light in closeproximity to the neoplastic tissue that is to be observed or destroyed:(2) have sufficiently low attenuation to permit an adequate intensity oflight; (3) transmit received luminescent light and feedback signals andthe like useful in observation and control; (4) be able to be insertedinto locations propitious for irradiating light at the desired location;(5) be capable of directing light in an appropriate pattern; (6) besufficiently strong to avoid breaking off of parts in use; (7) havesufficient capability to resist deterioration from the heat it handles;and (8) incorporates materials with low absorption at the frequenciesused in treatment so as to reduce heating.

In FIG. 9 there is shown a block diagram of a combination of radiationmonitor and treatment system having a laser system 10A, a monitoring andradiation control system shown generally at 12A and a delivery systemshown generally at 14A, positioned to radiate a tumor on a bronchialwall 16A of a subject. The laser system 10A generally radiates light ofthe desired frequency through the monitoring and radiation controlsystem 12A for delivery through a fiber optic delivery system to thecancer on the bronchial wall 16A.

The monitoring and radiation control system 12A includes a lightinterface system 20A and a monitor system 22A. The light interfacesystem 20A transmits light from the laser system 10A through thedelivery system 14A and transmits signals to the monitor system 22Aindicating the intensity of light transmitted to the delivery system14A. It also receives feedback light from the delivery system 14A andtransmits a signal representing that light to the monitor system 22A.The signals between the monitor system 22A and the light interfacesystem 20A are electrical.

The light interface system 20A includes an optical interface 24A, afilter 26A and a sensor 28A. The optical interface 24A, the filter 26Aand the sensor 28A are enclosed within a cabinet 34A for the shieldingof light with electrical conductors 36A connecting the sensor 28A to themonitor system 22A.

To transmit light from the laser system 10A to the delivery system 14A,the optical interface 24A includes a mirror 30A and a lens system 32A.The mirror 30A includes a central aperture which passes light from thelaser system 10A to the lens system 32A for transmission through thedelivery system 14A to the spot of therapy. Light is transmitted throughthe delivery system 14A from the spot of therapy back to the lens system32A for transmission to the filter 26A.

The delivery system 14A includes a plurality of light conductors 40A anda light transmission unit 42A connected together so that the lightconductors 40A receive light from the lens system 32A, originating withthe laser system 10A, and transmit light from a luminescent surface suchas neoplastic tissue containing photosensitive drug back to the lenssystem 32A for transmission to the filter 26A. There may optionally beincluded other types of equipment such as an endoscope 44A.

To monitor the therapy, the filter 26A is positioned between the mirror30A and the sensor 28A to pass a narrow band of frequencies to thesensor 29A which converts the light to an electrical signal fortransmission through the conductor 36A to the monitor system 22A. Themirror is positioned such that light from the delivery system 14Apassing through the lens system 32A is reflected by the mirror 30Athrough the filter 26A to the sensor 28A.

The light leaving the delivery system 14A from the tumor is in a conethat radiates over an area of the mirror 30A while the mirror 30A haslight from the laser system 10A forming a beam through the small centralaperture therein onto the lens 32A for transmission through a fiber ofthe light conductor bundle 40 onto the tumor. The signals from thedetector 29A may indicate the amount of illumination or the location ofillumination or the generation of triplet state oxygen indicatingdestruction of neoplastic tissue and thus may be used for locatingtumors or for indicating the amount of photodynamic destruction ofneoplastic tissue.

To reduce noise, the monitor 22A controls a chopper 98 to chop light ata suitable frequency such as 90 hz (hertz) which can be detected in themonitor system 22A by synchronous demodulation. This is controlled by asignal on conductor 100 which originates from the chopper drive voltage.This frequency is low enough so that the half life of the fluorescenceof the drug is much smaller than a half cycle of the chopper so as notto be blocked. The frequency of chopping is selected to block ambientnoise from room lamp sources and to reduce drift. Moreover, in thepreferred embodiment, the light transmitted through the delivery systemis 630 nm so as to be distinguished from 690 nm fluorescence from thedrug.

Although a delivery system 14A has been described which is suitable fortreatment of a tumor on a bronchial wall, other types of deliverysystems are known which transmit light for such use and otherconfigurations of delivery systems are available for other types oftherapy such as for bladder or the like.

In FIG. 10 there is shown a sectional view of a transmission unit 42 fortreating or locating a spot on a bronchial wall having a generallycylindrical shaped opaque casing 50, a fiber optic connecting socket 52and an image control section 54. The opaque casing 50 is sealed andcontains in one end, the fiber optic connecting socket 52 which isfunnel-shaped for receiving the ends of the fiber optic light conductorsinto the hollow interior of the opaque casing 50. The light conductorsare sealed in place by any suitable means such as by adhesive, molding,threading, swaging or the like.

The image control section 54 is fitted within the housing incommunication with the fiber optic conductors to focus light from thefiber optic bundle in a fixed configuration through a light-passingwindow 56 in the opaque casing 50 onto a spot to be treated and toreflect fluorescent light passing through the window 56 from tissue backto the ends of the fiber optic conductors in the fiber optic connectingsocket 52.

The image control section 54 includes one or more lens 60 and one ormore mirrors 62. The lens 60 and mirrors 62 are positioned with respectto the aperture 56 so that light from the lens 60 focuses an image ofthe ends of the fiber optic conductors in the connecting socket 52 ontothe mirror 62 which reflects that image through the aperture 56. Themirror also receives fluorescence and exciting light at fixed distancesfrom the light passing through the aperture 56 from the ends of thefiber optic connecting socket 52 back through the lens 60 onto lightconductors as a feedback signal. In the preferred embodiment, there arethree apertures to measure the attenuation coefficient of tissue, threemirrors, three lens and three light conductors forming three lightpaths, aligned with each other.

In FIG. 11 there is shown a developed view of a transmission unit 42having three apertures, lens, windows, mirrors and light conductors. Thefirst or end aperture 56 transmits light to a surface indicated at 70and two light receiver apertures are positioned side by side with thetransmitting aperture 56 at 72 and 74 spaced from each other bydistances R1 and R2 so that the receiver aperture 74 receives light at adistance R2 from the transmitted light and the receiver 72 receiveslight at a distance R1. The receivers are used because the lightreceived by a receiver yields information concerning: (1) totalattenuation coefficient of the tissue at the exciting frequency; (2)drug levels at certain fluorescent frequencies; and (3) theeffectiveness of treatment of tissue at certain other fluorescentwavelengths.

Moreover, it has been discovered that fiber conductors against thesurface of the tissue are able to receive a signal from the tissuewithout penetration of surface which represents the light diffusedthrough the surface The measurement of this light can be used fordysentery as described for the reading head 42 of FIG. 10 and theexplanation of FIG. 11 applies equally to such receivers.

Firstly, the measurement of light at the wavelength emitted by the drugin tissue provides a measure of the drug concentration. Secondly, themeasurement of light at the incident wavelength without drug in thetissue at points spaced from the location incident on the tissueprovides a measure of the attenuation constant and thus the penetrationfor certain intensities. Thirdly, the measurement of certain frequenciesat times related to energization of the drug and oxygen provides signalsrelated to destruction of undesirable tissue.

The amount of certain frequencies of emitted light is related to thedestruction of tissue and thus to the intensity of applied radiation,the attenuation constant in the tissue, the amount of drug, theavailability of oxygen and the distance from the incident radiation.Measurement of this radiation provides a general indication of activity.The fluorescent irradiance is linearly related to drug concentrationwith a known exciting irradiance so that a measure of drug concentrationis obtainable after calibration. From this relationship the clearance ofdrug from tissue can be determined after injection and during periodiclight treatment.

The depth of penetration of an adequate exciting radiation into tumorcan be estimated from the attenuation coefficient of tissue and theirradiance output increased to the value necessary for the selecteddepth chosen. The attenuation coefficient can be measured by biopsy orfrom a measurement of the irradiance at the exciting frequency at afirst and second location from the incident exciting radiation.

This coefficient is equal to the product of two factors. The firstfactor is the reciprocal of the difference between the distance from theincident radiation to the first point and the distance from the incidentradiation to the second point. The distances are both within the tissue.The second factor is the natural log of a fraction having a numeratorand a denominator. The numerator is the product of the measuredirradiance at the second point and the distance between the incidentirradiation and the second point. The denominator is the product of theirradiance at the first point and the distance between the incidentexciting radiation and the first point.

One type of apparatus for measuring the coefficient of attenuation isshown in FIG. 12 having a outer sheath 130, a transmitting lightconductor 132, a first light receiving conductor 134, a second lightreceiving conductor 136 and a spacing wedge 138. This apparatus is shownbroken away at 140 to illustrate that it may be longer than actuallyshown.

To measure the irradiance at the first and second points for calculationof the coefficient, the outer sheath 130 slidably confines the lightconductors 132, 134 and 136. It is sized to be inserted to the tissuebeing measured and to accommodate the transmission of light to thetissue through conductor 132 and the measurement of irradiance throughconductors 134 and 136. It may be inserted through an endoscope untilthe conductors 132, 134 and 136 contact the tissue.

To measure the distance between the incident radiation from conductor132 and the first and second point at conductors 134 and 136 forcalculating the coefficient of attenuation, the conductors are spaced atfixed angles to each other in a line by sheath 138 so that the distancebetween their ends can be trigonometrically calculated from the angleand the amount they are extended from the apex of the triangle. Theangles of the conductors are 30 degrees between conductors 132 and 134and 60 degrees between conductors 132 and 136. The lengths extended aremeasured by marks such as those shown at 140 on conductor 136 comparedto the edge of the sheath 138.

Of course, the distance may be fixed, but the embodiment of FIG. 12provides an adjustable device that may select different distances and beused for different tissue locations. The light conductors may bewithdrawn for protection during insertion. With the attenuation constantknown, the depth of penetration of a minimum irradiance or converselythe required irradiance for a minimum intensity at a given distance maybe calculated. The calculations are based on one of three expressions.

In the first expression, the light is emitted from a source that issubstantially a point source and the expression provides the treatmentdistance to a point of an assumed light flux density. In thisexpression, the length of treatment in tissue is the total lengththrough the tissue from the point source in any direction through thetreatment distance from the point source. Thus, the length of treatmentthrough tissue or along any straight line through the point sourceextends for a length equal to twice the treatment distance in thisexpression. It will cover a sphere or a section of a sphere having aradius equal to this distance.

In this first expression, the assumed minimum irradiance is equal to theirradiance at the point source divided by a denominator which is aproduct of two factors: the first being the distance from the pointsource to the point of assumed minimum irradiance and the second beingthe natural log base raised to the power of the product of the distanceand the attenuation coefficient. The attenuation coefficient is a numbercharacteristic of the tissue and has the dimensions of the reciprocal oflength. It is the reciprocal of the distance at which the irradiance isreduced by a factor of one divided by the natural log base.

In the second expression, the light is incident on the surface as anapproximate plane wave. In this expression, the distance of treatment isperpendicular to surface to a depth of the assumed necessary minimumirradiance. The minimum irradiance across the treatment distance isequal to a fraction having a numerator and denominator. The numerator isthe irradiance at the surface and the denominator is the natural logbase raised to the power of the product of the maximum treatmentdistance and the attenuation coefficient.

In the third expression, the light emitter is a cylinder embedded in thetissue and the space irradiance varies as the modified Bessel functionof the second kind of the O order, which decreases more slowly withdistance than does the function for a point source described above inexpression one.

In FIG. 13 there is shown a bulb-type light-emitting source 42A having alight transmission fiber 80 inserted in a diffusing bulb 82 whichreceives light, diffuses it within the bulb and emits it with equalintensity in all directions. This bulb may be used to irradiate a largearea such as a bladder or the like.

In FIG. 14 there is shown a sectional view of the light-emitting source42A having the light fiber 80 inserted into the diffusing bulb 82. Thediffusing bulb 82 is polycarbonate, held in place by epoxy glue 85 andcapable of transmitting light therethrough from ground surfaces 83 onthe ends of the light conductor 80. Alternatively, the surfaces 83 maybe fused as half a sphere to control the angle of irradiation or otherlenses may be used. Its inner surface is coated with a reflectivediffusing material 87, which in the preferred embodiment is formed ofparticles of sapphire united by epoxy to the inner surface to reflectlight within the diffusing bulb 82. However, it may be other reflectivematerials such as barium sulfate. Light is also forward scattered andemitted.

The diffusing bulb 82 is fluid tight, of sufficient size to avoid,during normal use, a temperature increase so great at any location as todegrade the material to the point of breaking. It is usually submergedin a fluid or semifluid matter and at a distance so the power density islow at the first surface that absorbs light. Thus, this surface incontact with blood receives light having an optical power density lowenough so that it remains relatively cool and blood does not coagulateon it.

In FIG. 15 there is shown a side elevational view of an eye applicator42B, having a hollow tubular stem 90 for receiving a fiber conductor anda reflector 92 positioned to receive light from the fiber conductor andreflect it onto a particular tumor. The hollow tubular stem 90 isrelatively stiff and "L" shaped with a plastic cylindrical socket 89 onone end and the reflector 92 on the other end so that the reflector 92may be inserted behind the eye with the socket 89 outside the eye toreceive a light conductor.

As best shown in FIG. 16, the socket 89 is tubular to receive and hold alight conductor so that light may be conducted through the hollowtubular stem 90 to an aperture 93 where the stem 90 joins the reflector92. The stem 90 is less than one eighth inch in diameter. The reflector92 includes a cylindrical reflective portion 95 covered by a transparentdiffusing surface 97.

As shown in FIG. 17, the reflector 92 is cap-shaped with a polishedreflective surface curved to reflect light it receives from the lightconductor 80A in multiple paths to obtain an even distribution. Thelight passes through a 400 micron light conductor 80A in the stem 90(FIGS. 15 and 16) and a 600 micron diameter quartz cylindrical lens 101that transmits light in paths parallel to the open end of the reflector92 through a wider angle than paths toward the open end. This increasesmultiple path reflections and even distribution of the light across theselected area, thus reducing spot intensity and covering an area.

The open end of the reflector 92 is either: (1) on the side closest tothe socket 89; or (2) furthest from a reflective back 95. It functionsto direct light into the eye or away from the eye onto optic nerves. Inthe former case, the open end is covered with the diffusing surface 99parallel to and aligned with the open end of the reflector 92 to diffuselight. The open end is sealed by a light passing member 95. In thelatter case, the open end faces in the opposite direction and is alsosealed by a light passing member.

In FIG. 18, there is shown still another light emitting source 42Chaving an emitting light conductor 144 and a receiving conductor 142. Inthis embodiment, the receiving light conductor fits against the surfaceto receive radiation within the tissue and spaces the emitting conductor144 to which it is attached from the surface of the tissue by a selecteddistance to irradiate a selected surface area of the tissue.

In FIG. 19, there is shown a schematic circuit diagram of a lightfeedback unit 37 (FIG. 8) having an electrical conductor 100, atransmitting fiber optic light conductor 106 of the bundle 40 (FIG. 8),an opaque housing 102 and an optical sensor 104. The light feedback unit37 develops a signal on conductor 100 for application to the monitorsystem 22 (FIG. 8) related to light transmitted through the fiber opticconductor 106 through the opaque housing 102 which is an opaqueinterface between the laser system 10 and the casing 74 for the lightinterface system 20 (FIG. 8).

To develop a feedback signal for application to the monitor system 22(FIG. 8) the feedback unit 37 includes an optical sensor 104 having alens 110, a light sensing diode 112, an amplifier 114 and a resistor116. The lens 110 receives light from the leakage spot through the fiberoptic conductor 106 and transmits it to the light sensing diode 112,which has its cathode electrically connected to one input of theamplifier 114 and its anode electrically connected to ground and to theother input of the amplifier 114. The resistor 116 is a feedbackresistor between the cathode of the light sensing diode 112 and theoutput of the amplifier 114.

The conductor 100 is electrically connected to the output of theamplifier 114 to provide a signal related to the light intensityimpinging upon the sensing diode 112. This signal may be used forcontrol and monitoring purposes.

In FIG. 20 there is shown a block diagram of the monitor system 22Ahaving the readout 25 (FIG. 8) which includes in the preferredembodiment a digital volt meter 124, a voltage control oscillator 126and a speaker 128. The photodiode 28 (FIG. 8) is electrically connectedto readout 25 through conductor 36 and converts the current signal fromthe sensor to a voltage output, which voltage output represents theamount of illumination from the treatment area. This may be furtherprocessed for use in the power control 23 if desired.

To provide a read-out of the amount of fluorescence resulting from aknown intensity of light on a treated area, the conductor 36 iselectrically connected to the digital volt meter 124 and to the voltagecontrol oscillator 126. The digital volt meter 124 is read directly andthe voltage control oscillator 126 generates an alternating currentvoltage which is applied to the speaker 128 to provide an audiblesignal, the pitch of which indicates the amount of fluorescence.

Although a digital volt meter and a speaker are used for visual andaudible indications to the user, other read-out techniques may be usedand a signal, although not used in the preferred embodiment, may beapplied to the lasers to alter intensity or frequency or both in afeedback system. The signal may also be utilized to generate a signalfor visual interpretation on an oscilloscope or to be applied to dataprocessing equipment for conversion to digital form and for furthercalculations. Moreover, it may be recorded on a chart or graph foranalysis later.

TESTS

While tests using the new drug have been performed principally onanimals, it is believed that equivalent results will be obtained onhumans, utilizing the same or less relative amount of drug to bodyweight.

                                      TABLE II                                    __________________________________________________________________________    PATIENT    DOSE mg/kg                                                         IDENTIFICATION                                                                           OF DRUG % OBSTRUCTION    LIGHT DOSE     RESPONSE                   __________________________________________________________________________    AP 164766  2.0     Right Upper Lobar Bronchus =                                                                   400 mw/cm-1.5 cm cyl.-                                                                       Complete Response                     2.0     very small nodule                                                                              for delivery 720 J/cm                                                                        both tumors                           2.0     Left Main Bronchus Stem =                                                                      (1) 500 mw/cm-3 cm cylinder                          2.0     5 × 3 mm   (2) 400 mw/cm-3 cm cyl. -                                                     200 J/cm                                                                      (3) Same as #2                                                                (4) Same as #2                            HW 167259  2.0     (L.) Bronchial Stump                                                                           540 J-1 cm cylinder-implant                                                                  #1 Partial Response                                                           25%                                   3.0 (Hpd)                                                                             Recurrence - s/p left                                                                          400 mw/cm-3 cm cylinder-                                                                     #2 Progression-                               pneumonectomy    implant        Started on Chemo           FW 167165  2.0     Left Main Bronchus Stem =                                                                      1 cm cylinder-200 J/cm                                                                       No Response at 48                                                             hrs.                                          100%             implant        post Rx                                                        Repeated × 1                                                                           Expired at home 5 wks                                                         after Rx                   PS 168674  2.0     Right Main Bronchus Stem =                                                                     500 mw/cm-3.3 cm. cylinder-                                                                  Partial Response-                             70%, also partial oc-                                                                          (750 J)        however disease pro-                          clusion of Left Main            gressed-expired                               Bronchus Branch and trachea                                                   Surgery                                                    __________________________________________________________________________

                                      TABLE III                                   __________________________________________________________________________    PATIENT                                                                       IDENTIFICATION                                                                           DOSE                                                                              % OBSTRUCTION  LIGHT DOSE    RESPONSE                          __________________________________________________________________________    MQ 168674  2.0 Right Main Bronchus Stem =                                                                   480 mw/cm-2.5 cm. cylinder-                                                                 No response-expired;                             100%           250 J/cm-implant                                                                            Respiratory failure 2                            Trachea = >50% Surface: 2.5 cylinder                                                                       months-post Rx                                                  125 J/cm                                        HN 167419  2.0 Right Main Bronchus Stem =                                                                   600 mw/cm-1 cm cylinder                                                                     Partial response at 4 days                       >90%           540 J/cm-implant                                post Rx                                                                                                     × 3     Expired 5 wks after RX-                                                       hemmorhage                        MM 167389  2.0 Left Main Bronchus Stem                                                                      600 mw/cm × 15 mins.-1                                                                No change at 72 hrs.-                            >90%           cylinder-540 J/cm                                                                           expired from pneumonia                                          implanted × 3                                                                         3 wks post PDT-massive                                                        involvement                       DL 167080  2.0 Left Main Bronchus Stem                                                                      500 mw/cm-1.2 cm cylinder                                                                   Partial response                                 >50%           450 J/cm × 2-Implanted                                                                expired from respiratory                                                      arrest (brain and bone                                                        mets.)                            WH 168271  2.0 Left Main Bronchus Stem                                                                      400 mw/cm-3 cm cylinder                                                                     No response-expired 5                            ˜90%     200 J/cm-treated S +                                                                        weeks post Rx-massive                                           interstitial simultaneously                                                                 disease                           apparently 2 separate                                                                                       tumors                                          __________________________________________________________________________

                                      TABLE IV                                    __________________________________________________________________________    PATIENT                                                                       IDENTIFICA-                                                                   TION     DOSE % OBSTRUCTION  LIGHT DOSE     RESPONSE                          __________________________________________________________________________    JJ 167585                                                                              1.5  Right Main Bronchus Stem                                                                     Day 3 = 400 mw/cm cylinder                                                                   ˜25% response-                            ˜75%     200 J/cm (8.5 min)                                                                           expired 1 month post PDT-                       Left Main Bronchus                                                                           Day 7 = 400 mw/cm-3 min cyl                                                                  pulmonary hemorrhage                            ˜75%     312 J/cm (13 min)                                MG 167240                                                                              2.0  Right Main Bronchus Stem =                                                                   350 mw/15 mins-straight                                                                      No Response                                     100%           fiber implanted × 2 times-                                              315 J/cm and surface PDT-                                                     400 mw total × 5 mins                                                   120 J/cm                                                  2.4                 400 mw × 8.5 mins on 1                                                                 Some Response-20%-30%                                          cylinder       Expired-pneumonia                                              200 J/cm-implanted × 3                     RF 166144                                                                              2.0  Right Main Bronchus Stem                                                                     500 mw/cm × 20 mins-3.2                                                                No Response                       100% with extension to                                                                 cylinder                                                                           Left Main Bronchus Stem                                                                      Implanted-600 J/cm                                        3.0                 300 mw/cm × 30 mins-3                                                                  No Response-expired-                                           cylinder       hemorrhage                                                     Implanted-540 J                                  LR 169121                                                                              2.0  Trachea        400 mw/cm-3 cm cylinder                                                                      Some Response-started                                          200 J/cm (8.5 mins) × 2                                                                chemo                             __________________________________________________________________________

                                      TABLE V                                     __________________________________________________________________________    PATIENT                                                                       IDENTIFICA-                                                                   TION     DOSE % OBSTRUCTION  LIGHT DOSE      RESPONSE                         __________________________________________________________________________    SM 166462                                                                              2.0  Right Main Bronchus Stem                                                                     500 mw/cm × 20 mins-3                                                                   Marked decrease of tumor                       ˜50%     cylinder-600 J/cm                                                                             protrusion into lumen at                       S/P-Right Upper Lobectomy      6 days PDT-did not                                                            return                           DS 161223                                                                              2.0  Left main Bronchus Stem =                                                                    400 mw/cm × 8 mins and                                                                  Partial response                               70%            500 mw/cm × 13 mins-both                                                                receiving chemo                                               3 cm cylinders-200 J/cm and                                                   400 J/cm                                         EB 169173                                                                              2.0  L.L.L. = >90%  400 mw/cm × 8.5 mins-                                                                   Partial response                                              3 cm cylinder-200 J/cm                                                                        4 days post PDT                  WE 167155                                                                              2.0  Right Main Bronchus Stem =                                                                   500 mw/cm × 20-3 cm                                                                     Partial response                               +50%           cylinder-600 J/cm                                                                             6 months post PDT-                                                            hemorrhage                       RF 165513                                                                              2.0  Right Bronchus Inter-                                                                        400 mw/lin cm × 8 mins = 3                                                              No response-expired 5                          medius = 80%   cylinder-192 J/cm                                                                             days post PDT-handle                                                          secretions extensive in-                                                      volvement-expired-                                                            pneumonia cause of death:                                                     pneumonia                        __________________________________________________________________________

Tests have been, to a limited extent, performed on humans withendobronchial tumors to support this opinion as shown in tables II, III,IV and V. It is believed that the aforedescribed treatment utilizing thedrug of the invention, can be used repeatedly without cumulative damageto normal tissues, providing that treatment is not overly aggressive.This is supported by the data of tables II, III, IV and V as well.Furthermore, recent tests of patients utilizing the drug DHE at doses toproduce equal or better results compared to the prior art drug haveresulted in markedly lower toxicity of healthy tissue in lung cancerpatients.

While the aforementioned animal tests utilized a dosage of the new drugof approximately 4 mg/kg of body weight, in the treatment of the tumorsin humans, dosages as low as 1 mg/kg of body weight are believedeffective in utilizing the new drug. In any event dosages of the newdrug of only approximately one-half of the prior art dosages areequivalently effective in accomplishing necrosis of tumors.

Also, while the aforementioned animal tests utilized illumination oneday following injection of the new drug and the human tests 2 to 3 days,it is believed that a delay of up to seven days prior to illuminationstill will accomplish necrosis, and a time delay of three hours to threedays between injection and illumination is generally believed at thistime preferable in humans in order to achieve the best therapeutic ratioof drug in undesirable tissue to drug in normal tissue. However, it isbelieved that these differ in various types of tissues. The optimumtherapeutic ratio can be determined by experience and measurement offluorescence and the ratio which provides destruction of the undesirabletissue with minimum change to the normal tissue is selected based o thedrug level in both the undesirable and normal tissue.

Furthermore, while an intensity of 160 mw/cm² for 30 minutes wasutilized to activate the drug, it is believed that an intensity as highas 1 watt/cm² for 20 minutes or as low as 5 mw/cm² for an extendedperiod of time may be utilized to accomplish necrosis. Less than 5mw/cm² of illumination intensity will probably have no therapeuticeffect, irrespective of time of application. More than 400 mw/cm² maycause undesirable thermal effects in some cases. For insertedcylindrical fibers, powers in the range of 50 to 500 mw/cm of emittinglength are used without thermal effects or above 500mw/cm if thermaleffects are desired.

DBA2 Ha/D mice were transplanted with SMT-F tumors. When thetransplanted tumors reached 5-6 mm (millimeters) in diameter, the micewere injected with a dose of 7.5 milligrams of the crude prior artLipson derivative per kilogram of body weight for comparison purposes

Approximately 24 hours following the injection, the tumor areas of themice were shaved to remove the fur. The mice were exposed to red light(600-700 mw) from an arc lamp at an intensity of 160 mw (milliwatts) persquare centimeter for 30 minutes. Ten of twenty mice showed no apparenttumors seven days after treatment. The injected drug is retained in thetumor cells longer as compared to normal tissue.

This protocol was repeated using the new drug disclosed in thisinvention and equivalent results were obtained but using a drug dose ofapproximately one half (4 mg/kg of body weight), as compared to theprior art Lipson drug.

In further tests ICR Swiss (Albino) mice were injected with atherapeutic dose of the crude Lipson derivative (7.5 mg/kg of bodyweight). Approximately 24 hours following such injection, the hind feetof the mice were exposed to the same light conditions used in theaforesaid tumor response study. The damage to the hind feet was assessedas 2.0 on an arbitrary scale where 0.0 is no damage and 5.0 is completenecrosis.

                  TABLE 1                                                         ______________________________________                                        TISSUE LEVELS OF .sup.3 H-HPD AND                                             .sup.3 H-DHE (μg/g wet tissue)                                             DBA/2 Ha MICE, SMT-F TUMOR                                                    ______________________________________                                        Injected Dose                                                                 (mg/kg)     Liver       Kidney   Spleen                                       ______________________________________                                        10-Hpd 24 h 14.2 ± 2 9.7 ± 2.1                                                                           7.1 ± 1.2                                 5-DHE 24 h  19.1 ± 3.3                                                                             8.3 ± 2.3                                                                           8.1 ± 2.9                                 10-Hpd 72 h 13.8 ± 6 7.3 ± 3                                                                             6.1 ± 1.1                                 5-DHE 72 h  15 ± 4   7.6 ± 2.5                                                                           6.6 ± 1.4                                 ______________________________________                                        Injected Dose                                                                 (mg/kg)     Lung     Muscle      Brain                                        ______________________________________                                        10-Hpd 24 h 1.9 ± 0.4                                                                           0.76 ± 0.25                                                                            0.33 ± 0.15                               5-DHE 24 h  2.7 ± 1.4                                                                           0.68 ± 0.26                                                                            0.19 ± 0.1                                10-Hpd 72 h 2.3 ± 0.9                                                                           1.2 ± 0.7                                                                              0.7 ± 0.4                                 5-DHE 72 h  2.3 ± 0.8                                                                           1.9 ± 0.6                                                                              0.9 ± 0.6                                 ______________________________________                                        Injected Dose                                                                 (mg/kg)      Skin           Tumor                                             ______________________________________                                        10-Hpd 24 h  3.5 ± 1.2   3.6 ± 1.1                                      5-DHE 24 h   3.4 ± 1.3   3.5 ± 1.2                                      10-Hpd 72 h  2.8 ± 1.9   2.3 ± 1.08                                     5-DHE 72 h   1.9 ± 0.6   1.6 ± 0.5                                      ______________________________________                                         Minimum number of animals per tissue was 10, maxium 17. Tumor volume          doubling is approximately 3 days.                                        

Moist desquamation was evident and the foot area slowly returned tonormal after about 40 days. This protocol was repeated using the newdrug disclosed in this application in doses of 4 mg/kg of body weight.Only slight erythema and/or edema was noticed following treatment for ascore of less than one on the aforementioned scale of damage. Thiscondition disappeared after 48-72 h (hours) with no residual effects.This leads us to believe that skin photosensitivity may no longer be asignificant problem when using this new drug.

A summary of further tests on animals is shown in table one for micecomparing unpurified HPD and the purified DHE new drug indicating druglevels in mice.

From the foregoing description and accompanying drawings, it will beseen that the invention provides a new and novel drug, useful in thediagnosis and treatment of tumors, permitting utilization of reducedamounts of the drug as compared to related prior art drugs and whichresults in less severe side effects. The invention also provides a novelmethod of producing the new drug, together with a novel method ofutilizing the drug in the treatment of tumors.

The terms and expressions which have been used are used as terms ofdescription and not of limitation and there is no intention in the useof such terms and expressions of excluding any equivalents of any of thefeatures shown or described, or portions thereof. Moreover, variousmodifications in the preferred embodiment are possible within the scopeof the claimed invention.

What is claimed is:
 1. A process for the in vivo destruction of tumors in a host comprising the steps of:injecting into said host a composition comprising porphyrin aggregates which are fluorescent, photosensitizing and capable of localizing in and being retained in tumor cells for a longer time than in normal tissues, which composition is prepared by a process which comprises raising the pH of a hematoporphyrin derivative preparation in aqueous medium to 6.5-2 to obtain said porphyrin aggregates of 10 kd or greater; and separating said aggregates from the remainder of the hematoporphyrin derivative preparation to obtain said composition; wherein said hematoporphyrin derivative preparation has been prepared by treating hematoporphyrin hydrochloride with a mixture of acetic acid and sulfuric acid; waiting for a predetermined period of time; and illuminating the tumor tissue with light at a predetermined intensity.
 2. The process of claim 1 wherein said composition is used in a dosage of from about 1 to 4 mg/kg of body weight of the host.
 3. The process of claim 1 wherein the time delay between the injection and illumination is within a range of about 3 hours to 7 days.
 4. The process of claim 1 wherein said intensity of illumination is at least 5 mw/cm².
 5. The process of claim 1 wherein said illuminating step is conducted by transmitting radiation through a light conductor to a location adjacent to the tumor tissue and transmitting the radiation through a diffuser onto the tumor.
 6. The process of claim 5 which further includes transmitting radiation from the tumor back to the source of radiation through a light conductor and using said radiation to control the dosage of radiation.
 7. The process of claim 5 wherein transmitting radiation through a diffuser includes transmitting radiation through an air fill bulb whereby heat is dissipated.
 8. The process of claim 4 wherein the intensity of illumination is between 0.5 w/cm² and I kw/cm², whereby thermal effects are obtained.
 9. The process of claim 1, wherein said pH to which said hematoporphyrin derivative preparation in aqueous medium is raised is about 9.5.
 10. The process of claim 1 wherein the separation is effected by filtering.
 11. The process of claim 10 wherein the pH of 9.5 is maintained during filtration. 